Nursing and Midwiferyhttp://hdl.handle.net/2262/47
Nursing and Midwifery

2019-02-22T16:07:27ZAnxiety during pregnancy and at three months postpartum: prevalence, variations and associated factors in a cohort of nulliparous womenhttp://hdl.handle.net/2262/86026
Anxiety during pregnancy and at three months postpartum: prevalence, variations and associated factors in a cohort of nulliparous women
RAFFERTY, LOUISE ANN
Anxiety during pregnancy and at three months postpartum: prevalence, variations and associated factors in a cohort of nulliparous women. Background. As an adaptive emotion, anxiety enhances reactions to challenging life experiences. However, anxiety can become overwhelming and debilitating. In two longitudinal studies, the prevalence of anxiety ranged from 12.2% to 14.6% in pregnancy, decreasing to 4.8% and 8.1% respectively at three months postpartum. However, the prevalence varies considerably depending on the definition of anxiety, the measurement scales used, the population studied, the time of assessment and the study's attrition rates. There is a dearth of information available on the prevalence of perinatal anxiety amongst women in Ireland. Objectives The objectives were to: i) determine the prevalence of anxiety in first-time mothers in pregnancy and at three months postpartum; ii) explore the changes in prevalence between pregnancy and three months postpartum; (iii) identify the existence of the co-morbidities of depression and stress, at both time points, and (iv) to report the factors associated with anxiety in pregnancy and at three months postpartum. Methods The cohort of women and data for this study were identified from the longitudinal prospective cohort Maternal health And Maternal Morbidity in Ireland study (MAMMI study). Prevalence of anxiety was determined using two measurement scales, the anxiety items in the Edinburgh Postnatal Depression Scale (EPDS 3A), the anxiety subscale within the Depression, Anxiety and Stress Scale 21 (DASS 21 anxiety subscale), and a single item statement from a sample of 1668 women who completed self-administered surveys at two time points. A range of sociodemographic and clinical factors, identified from the surveys and women's hospital records, were assessed for associations with anxiety. Results Prevalence of anxiety in pregnancy was 9.3%, 15.1% and 26.4%, depending on the measurement scales and the cut-off scores used. At three months postpartum, prevalence decreased from 9.3% to 8.7% and from 26.4% to 24.6%, measured using EPDS 3A cut-off scores &#8805;6 and &#8805;4 respectfully, and from 15.1% to 8.6% according to the DASS 21 anxiety subscale. According to the single item statement, prevalence increased from 12.4% in pregnancy to 28.1% at three months postpartum. Prevalence of anxiety was greater than depression or stress in pregnancy however, it was lower postpartum. Factors significantly associated with anxiety using both the DASS 21 and the EPDS 3A in pregnancy included country of birth, educational level and smoking. Postpartum, educational level, relationship problems with husband/partner, fear of any partner, a need for more emotional support and breastfeeding were significantly associated with anxiety according to both scales. At both time points and for both scales the single item anxiety statement for experiences of anxiety in a life time was significantly associated with anxiety. Conclusion Findings show that prevalence of anxiety in the same cohort of women varied widely at and between the two time points; in pregnancy and at three months postpartum. While the prevalence of anxiety decreased between the two time points according to the measurement scales used, the decrease was greatest using the DASS 21 which has yet to be validated for use in pregnancy. There was less of a decrease in prevalence, according to the EPDS 3A at both time points and according to both cut-off scores. On the other hand, prevalence increased between pregnancy and three months postpartum according to the single statement. Nonetheless, it was found that a considerable proportion of first time mothers report anxiety in pregnancy and at three months postpartum irrespective of the measurement scale or statement used.
APPROVED
2019-01-01T00:00:00ZPostpartum sexual health in nulliparous women in Ireland: a mixed methods studyhttp://hdl.handle.net/2262/86020
Postpartum sexual health in nulliparous women in Ireland: a mixed methods study
O'MALLEY, DEIRDRE
Background: Prevalence rates of postpartum sexual health issues and associated factors vary greatly in the published literature. There is a focus on biophysical measures of postpartum sexual health and a lack of women's voices on the topic. The aim of this study is to identify the prevalence of and risk factors for postpartum sexual health issues and to explore women's experience of their sexual health after the birth of their first baby. Methods: A mixed methods explanatory sequential study design with connected integration was utilised which had an initial quantitative phase (longitudinal cohort survey design) with 832 nulliparous women from one maternity site in Ireland. Data were collected in early pregnancy and at three, six, nine and twelve months postpartum. In the second phase (qualitative descriptive approach) a subsample of twenty-one women were interviewed using semi-structured interviews which were analysed using the constant comparative analysis method. Results: Most women had resumed sexual activity three months postpartum (77.5%). Prevalence rates of sexual health issues (e.g. dyspareunia, lack of vaginal lubrication and problems with orgasm) increased immediately postpartum but returned to pre-pregnancy levels or less twelve months postpartum. With the exception of loss of interest in sex, which was still experienced by 40% of women twelve months after birth. Pre-existing dyspareunia (AOR 2.6, CI 95% 1.8-3.6, p<0.001), 3rd degree perineal tears (AOR 4.1, CI 95% 1.3-12.3, p=0.013) and breastfeeding (AOR 1.9, CI 95% 1.3-2.7, p<0.001) were identified as risk factors for experiencing dyspareunia six months postpartum. Twelve months postpartum, being older (>35 years) and experiencing pre-pregnancy dyspareunia remained predictive for dyspareunia. Loss of interest in sex six months postpartum was associated with pre-existing dyspareunia (AOR 1.4, CI 95% 1.0-1.9, p=0.05), breastfeeding (AOR 2.2, CI 95% 1.6-3.0, p<0.001) and being never satisfied with one?s body image (AOR 2.8 CI 95% 1.6-4.6 p<0.001). Twelve months postpartum, breastfeeding (AOR 1.6, CI 95% 1.0-2.4, p=0.029) and being never happy with one?s body image (AOR 3.6, CI 95% 1.9-6.7, p<0.001) remained risk factors for experiencing a loss of interest in sex. Despite prevalence rates of postpartum sexual health issues, a high proportion of women reported being satisfied (68%) with their overall sexual life twelve months after birth. Six themes emerged from the interviews about women's experience of their sexual health after the birth of their first baby. Intimacy and sexual activity were important aspects of a couple?s relationship. Women described ongoing challenges to intimacy and sexual activity (physical and psychological). They also described the strategies they developed to overcome sexual health issues, such as, planning sexual activity and communicating their fears, anxieties, altered interest in sex and associated feelings of guilt. In the absence of information and support from healthcare professional around changes to sexual health after birth, women sought alternative sources of help and support from peers and the internet. Conclusion: The findings of this study demonstrate the complex nature of postpartum sexual health. While sexual health issues are commonly experienced after birth, many women remain satisfied with their overall sexual life one year after birth. Pre-existing dyspareunia, breastfeeding and a poor perception of one's body image were risk factors for experiencing postpartum sexual health issues. Women were unprepared for the changes to their intimate relationship but they became positive agents in findings solutions for their sexual health issues. Examining postpartum sexual health from a biophysical perspective only, does not take into account the relational and psychological issues that this study has identified as being important to women with regards their intimate relationship and sexual health after the birth of their first baby.
APPROVED
2019-01-01T00:00:00ZSpecial Issue 'International Conference of Spirituality in Healthcare. Nurturing the Spirit', Trinity College Dublin 2016http://hdl.handle.net/2262/85906
Special Issue 'International Conference of Spirituality in Healthcare. Nurturing the Spirit', Trinity College Dublin 2016
Brady, Vivienne; Timmins, Fiona
This is an editorial of a Special Issue regarding the International Conference of Spirituality in
Healthcare held in the School of Nursing and Midwifery, Trinity College Dublin, Republic of Ireland
(ROI), on June 2016 (Spirituality Research and Innovation Group 2016). This event was the second
international spirituality in healthcare conference hosted by Trinity College Dublin, with a third
international conference planned for 22 June 2018. Conferences such as this provide a unique
opportunity for academics and clinicians in healthcare to share their research findings, clinical practice
and emerging ideas. The conference is international and multidisciplinary and as such provides a
novel space and platform for discussion and debate on the topic. The editorial draws together a
selection of published papers, arising from the conference; collectively these demonstrate a continuing
and growing interest in the subject of spiritualty in healthcare.
PUBLISHED
2017-01-01T00:00:00ZDeveloping Agreed and Accepted Understandings of Spirituality and Spiritual Care Concepts among Members of an Innovative Spirituality Interest Group in the Republic of Ireland.http://hdl.handle.net/2262/85905
Developing Agreed and Accepted Understandings of Spirituality and Spiritual Care Concepts among Members of an Innovative Spirituality Interest Group in the Republic of Ireland.
Brady, Vivienne
A Spirituality Interest Group (SIG) was set up in in the School of Nursing and Midwifery,
Trinity College Dublin, Republic of Ireland (ROI), in March 2013. This paper reports on some of
the journey and requirements involved in developing the group. It highlights the essential work
of establishing agreed understandings in an objective way in order for the group to move forward
with action. These agreed understandings have contributed to the group’s success. Outlining the
group’s journey in arriving at agreements may be of use to others considering creating similar groups.
One key action taken to determine the suitability of the group’s aims and terms of reference was
the distribution of a Survey Monkey to group members (n = 28) in 2014. One early meeting of the
group discussed future goals and direction using the responses of this anonymous survey. This paper
reports on the results of the survey regarding the establishment of the SIG and the development of a
shared understanding of spiritual care among the members. There is consensus in the group that
the spiritual care required by clients receiving healthcare ought to be an integrated effort across the
healthcare team. However, there is an acceptance that spirituality and spiritual care are not always
clearly understood concepts in practice. By developing shared or at least accepted understandings of
spirituality and spiritual care, SIG hopes to be able to underpin both research and practice with solid
foundational conceptual understanding, and in the process also to meet essential prerequisites for
achieving the group’s aims.
PUBLISHED
2016-01-01T00:00:00Z